Conference Abstract| March 01 1992 Increases in Coronary Sinus Atrial Natriuretic Peptide and Lactate Levels during Angioplasty JS Gill; JS Gill 1Department of Cardiological Sciences, St George's Hospital Medical School, London SW17 ORE, UK Search for other works by this author on: This Site PubMed Google Scholar JT Stewart; JT Stewart 1Department of Cardiological Sciences, St George's Hospital Medical School, London SW17 ORE, UK Search for other works by this author on: This Site PubMed Google Scholar J Mazurkiewicz; J Mazurkiewicz 1Department of Cardiological Sciences, St George's Hospital Medical School, London SW17 ORE, UK Search for other works by this author on: This Site PubMed Google Scholar CP Pumphrey; CP Pumphrey 1Department of Cardiological Sciences, St George's Hospital Medical School, London SW17 ORE, UK Search for other works by this author on: This Site PubMed Google Scholar D Redwood; D Redwood 1Department of Cardiological Sciences, St George's Hospital Medical School, London SW17 ORE, UK Search for other works by this author on: This Site PubMed Google Scholar DE Ward; DE Ward 1Department of Cardiological Sciences, St George's Hospital Medical School, London SW17 ORE, UK Search for other works by this author on: This Site PubMed Google Scholar AJ Camm AJ Camm 1Department of Cardiological Sciences, St George's Hospital Medical School, London SW17 ORE, UK Search for other works by this author on: This Site PubMed Google Scholar Author and article information Publisher: Portland Press Ltd Online ISSN: 1470-8736 Print ISSN: 0143-5221 © 1992 The Biochemical Society and the Medical Research Society1992 Clin Sci (Lond) (1992) 82 (s26): 37P. https://doi.org/10.1042/cs082037P Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Cite Icon Cite Get Permissions Citation JS Gill, JT Stewart, J Mazurkiewicz, CP Pumphrey, D Redwood, DE Ward, AJ Camm; Increases in Coronary Sinus Atrial Natriuretic Peptide and Lactate Levels during Angioplasty. Clin Sci (Lond) 1 March 1992; 82 (s26): 37P. doi: https://doi.org/10.1042/cs082037P Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsClinical Science Search Advanced Search This content is only available as a PDF. © 1992 The Biochemical Society and the Medical Research Society1992 Article PDF first page preview Close Modal You do not currently have access to this content.

Fourteen patients undergoing routine cardiac catheterisation were paced at a steady frequency; after this test, stimuli were introduced with a variable preceding interval (test pulse interval). The QT interval of the electrocardiogram and the duration of the monophasic action potential of the right ventricle were measured. QT interval is a function of action potential duration; the two variables were very closely correlated in this study. Both these variables increased in duration with increasing test pulse interval. A biphasic response, as previously reported, was not seen. An increase in steady state pacing frequency caused QT interval and action potential duration to decrease for any given R-R interval. When frequency of stimulation was suddenly increased and then maintained, there was an immediate action potential shortening followed by a further more gradual shortening occurring over several minutes. These results imply that a simple correction of QT interval for heart rate (QTc) is inadequate. It is concluded that the relation between action potential duration (or QT interval) and heart rate depends on both the instantaneous interval between beats and the duration of the prevailing heart rate.

We describe an asymptomatic patient with multiple fistulae between coronary arteries and the main pulmonary artery with an insignificant left-to-right shunt. Possible embryological basis of this anomaly is discussed.

Twenty-six adult patients, classified by clinical and catheter criteria into groups of those with normal and abnormal left ventricular function, were studied during cardiac catheterization. Right heart pacing was established, and left ventricular dP/dt was measured with end-catheter manometers. By varying the interval preceding a test beat after periods of steady pacing it was confirmed that recovery of left ventricular mechanical function (maximum dP/dt) occurs approximately 800 msec (optimum interval) after a beat. The augmentation of maximum dP/dt of the first 2 beats after an extrasystole, each spaced at the optimum interval, was also studied; the amount of potentiation was varied by alterations in extrasystolic interval. Potentiation decayed from the first to the second postextrasystolic beat with a ratio that was fixed in each individual patient. The ratio (recirculation fraction) was higher in patients with normal than in those with abnormal left ventricular function (mean +/- SD 0.52 +/- 0.10 vs 0.37 +/- 0.11, p less than .005). There was an inverse relationship between this ratio and the degree of potentiation of the first postextrasystolic beat (r = .80, p less than .001). We postulate a disturbance of excitation-contraction coupling mechanisms to explain these effects.

Conference Abstract| December 01 1984 Short Onset-Time and Morphology of st Segment Depression and Poor Bp Response on Exercise is Related to Severity of Coronary Disease after Myocardial Infarction D Mannering; D Mannering 1Depts Medicine 1 and Cardiology, St George's Hospital and Medical School, London SW17 Search for other works by this author on: This Site PubMed Google Scholar E.D. Bennett; E.D. Bennett 1Depts Medicine 1 and Cardiology, St George's Hospital and Medical School, London SW17 Search for other works by this author on: This Site PubMed Google Scholar M Dancy; M Dancy 1Depts Medicine 1 and Cardiology, St George's Hospital and Medical School, London SW17 Search for other works by this author on: This Site PubMed Google Scholar D Ward; D Ward 1Depts Medicine 1 and Cardiology, St George's Hospital and Medical School, London SW17 Search for other works by this author on: This Site PubMed Google Scholar D Redwood D Redwood 1Depts Medicine 1 and Cardiology, St George's Hospital and Medical School, London SW17 Search for other works by this author on: This Site PubMed Google Scholar Clin Sci (Lond) (1984) 67 (s9): 55P. https://doi.org/10.1042/cs067055P Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Citation D Mannering, E.D. Bennett, M Dancy, D Ward, D Redwood; Short Onset-Time and Morphology of st Segment Depression and Poor Bp Response on Exercise is Related to Severity of Coronary Disease after Myocardial Infarction. Clin Sci (Lond) 1 December 1984; 67 (s9): 55P. doi: https://doi.org/10.1042/cs067055P Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsClinical Science Search Advanced Search This content is only available as a PDF. © 1984 The Biochemical Society and the Medical Research Society1984 Article PDF first page preview Close Modal You do not currently have access to this content.

We have studied the echocardiographic and phonocardiographic findings in 18 patients with obstruction to ventricular outflow at subpulmonary valve level. The aetiology was congenital in 13 patients, a result of hypertrophic cardiomyopathy in three, and infiltration of the right ventricular outflow tract by glycogen or lymphoma in the remaining two. Abnormal systolic motion of the pulmonary valve, fluttering, and early or midsystolic closure were seen in 16 of 17 patients in whom the cusps were visualised. Normal pulmonary valve motion was found in one patient with coexisting pulmonary valve stenosis. In congenital infundibular stenosis the delay of the pulmonary component of the second heart sound (P2) was related to the severity of the obstruction. A pulmonary ejection sound, defined as a high-frequency sound occurring at the moment of full pulmonary valve opening, was absent except in the patient with coexisting pulmonary valve stenosis. In hypertrophic cardiomyopathy with obstruction to the right ventricular outflow, the ejection systolic murmur was softer with inspiration, a finding that contrasts with the respiratory variation seen with fixed obstruction. Recognition of these abnormalities should allow an accurate non-invasive diagnosis to be made and permit assessment of severity when P2 can be recorded.

This study summarizes the results in 26 patients of triple valve replacement (TVR) performed between 1967-1975. The first ten patients (group I) received all-mechanical valves, but the last 16 (group II) received porcine xenograft atrioventricular and porcine or mechanical aortic valves. Preoperatively, all patients were functional class II or IV with pulmonary arterial and venous hypertension. Early mortality was 30% group I and 18.8% group II; late mortality has been 30% group I and 6.3% group II. Total operative and bypass time, and duration of postoperative respiratory support was less (P less than 0.025) in group II than in group I. Postoperative catheterization performed in 16 of 26 patients demonstrated significant reduction (P less than 0.05) in pulmonary arterial and venous hypertension, and aortic and mitral gradients in group II. There have been no late complications or valve malfunctions in group II. An improvement of at least two functional classes was seen in 4/6 group I and 12/13 group II operative survivors. The results of TVR with porcine xenografts compare favorably with those of all-mechanical replacements and deserve further evaluation.

Nitroglycerin is generally believed to be contraindicated during acute myocardial infarction because the resultant decrease in coronary perfusion pressure and reflex tachycardia might extend the area of ischemia. To determine the effects of nitroglycerin and alterations in arterial pressure on the degree of myocardial ischemia, the left anterior descending coronary artery was occluded for repeated 15-min periods in closed-chest conscious dogs. The degree of myocardial ischemia was estimated by summating the S-T segment elevation (∑ST) recorded from 12 myocardial electrodes. Although heart rate increased and arterial pressure decreased, ∑ST after 15 min of coronary occlusion was 14 ± 3 mv (P < 0.02) less during nitroglycerin therapy than during control occlusions. When the same alteration in arterial pressure was produced by venous hemorrhage, ∑ST tended to be greater than during control occlusions (+14 ± 7 mv, NS); the difference between the nitroglycerin and hemorrhage interventions was highly significant (28 ± 9 mv, P < 0.02). ∑ST was also less than control when phenylephrine was administered in doses sufficient to increase arterial pressure 25 mm Hg (−16 ± 3 mv, P < 0.005) and 50 mm Hg (−15 ± 2 mv, P < 0.001). When the decrease in arterial pressure and reflex tachycardia induced by nitroglycerin were reversed by simultaneous infusion of methoxamine, ∑ST was greatly reduced from control (−50 ± 16 mv, P < 0.02) and was significantly less than that occurring during nitroglycerin alone (−25 ± 5 mv, P < 0.001). We conclude that nitroglycerin may be a useful agent during acute myocardial infarction, particularly when the fall in coronary perfusion pressure and increase in heart rate are prevented by the simultaneous administration of an alpha-adrenergic agonist.

The cause of chronic heart block is often obscure on clinical grounds alone.Consequently there is considerable difficulty in deciding the prognosis of a patient with complete heart block even with successful artificial pacing.Coronary artery disease has been generally accepted in the past as the pre- dominant cause of heart block, and Penton, Miller, and Levine ( 1956) estimated an incidence of 43 per *cent, Wright et al. ( 1956) one of 69 per cent, and Friedberg, Donoso, and Stein (1964) one of 48 per TABLE I HISTOLOGICAL FINDINGS, SEX, AND AGE ON REFERRAL IN 65 CONSECUTIVE PATIENTS WITH CHRONIC HEART BLOCK Men Women Age (yr.)Total Bilateral bundle-branch fibrosis 14 12 36-82 (mean 70) 26 (Group 1) Cardiomyopathy 8 3 50-82 (mean 69) 11 (Ciroup 2) Coronary artery disease 7 3 56-80 (mean 69) 10 (Group 3) Myocarditis 1 3 45-68 (mean 59) 4 (Group 4) Calcification of valve or valve rings 2 2 68-76 (mean 71) 4 (Group 5) Collagen disease 3 0 59-68 (mean 62) 3 (Group 6) Amyloid deposits 2 0 68 and 84 2 G Transfusion siderosis 2 0 10 and 17 21r 7) Aneurysm of membranous septum 0 1 62 1 Congenital heart block o0 1 54

A study of 203 patients with chronic heart block treated with oral long-acting isoprenaline showed that 85 (42%) were maintained satisfactorily on the drug for a mean period of 18.2 months. The survival rates at one, two, and three years were 76%, 64%, and 57% respectively. In 115 patients treatment by pacing became necessary to control symptoms, and in these patients the survival rates at one, two and three years were 83%, 72%, and 60%.The two most valuable guides to patients' response to oral isoprenaline are the response to a trial dose of intravenous isoprenaline and the type of dysrhythmia associated with their Adams-Stokes attacks. Patients with heart failure with slow ventricular rates and those with angina of effort do not respond to treatment with sympathomimetic drugs.The majority of patients with chronic heart block are elderly, and in view of the complexity of pacing systems, and the need for skilled supervision of paced patients, oral long-acting isoprenaline remains of value in the longterm management of chronic heart block, provided patients are carefully selected for this form of therapy.

The use of sustained-action isoprenaline in the treatment of patients with heart block is well established (Dack and Robbin, 1961; Fleming and Mirams, 1963; Bluestone and Harris, 1965). Though isoprenaline has less tendency than adrenaline to stimulate ventricular ectopic foci, fatal arrhythmias are produced in some patients, and Bluestone and Harris (1965) have given a preliminary report of the necessity for testing the effect of a brief high blood level of isoprenaline while under close supervision, before embarking on therapy with the sustained-action preparation. The results of intravenous and oral isoprenaline are reported in 23 patients with heart block and Stokes-Adam attacks. At the same time the opportunity has been taken to compare the effect of isoprenaline and orciprenaline intravenously. Both drugs have positive chronotropic and inotropic effects on the heart and in this respect are similar to adrenaline. In patients with complete heart block isoprenaline and orciprenaline in crease both atrial and ventricular rates, but have less tendency than adrenaline to stimulate ventricular ectopic foci. Cardiac output is increased, ejection time is reduced, and there is a fall in atrial pressure (Stack et al., 1958). The depressor effect on the peripheral vascular resistance results in a fall in diastolic pressure with either no change or a slight fall in systolic pressure (Schumacher and Schmock, 1954; Spitzbarth and Albers, 1961 ; Palmero, 1965). The 23 patients were consecutive cases of atrioventricular block 'admitted to hospital for consideration of pacing who had not had a trial of long-acting isoprenaline in full dosage.

Artificial pacing for chronic heart block has not yet dramatically improved the expectation of life, though the quality of life has undoubtedly been improved. The 1-year survival rate for untreated patients with chronic complete heart block is possibly 60 per cent (Friedberg, Donoso, and Stein, 1964; Johansson, 1966), but an accurate estimation is difficult to determine from the published reports (Siddons and Sowton, 1967). The 1-year survival rate for 108 patients paced at St. George's Hospital is 78 per cent, which is comparable to other centres (Chardack et al., 1965; Elmqvist and Senning, 1960; Nathan et al., 1963; Taylor, 1966; Zoll et al., 1961). In an attempt to find an explanation for this still relatively high mortality (22%), an analysis has been made of the clinical and pathological findings in all patients who came to necropsy following pacing in the past 4 years.

Acute heart block is an uncommon but serious complication of myocardial infarction, though survivors usually return to sinus rhythm.Chronic heart block associated with Stokes-Adams attacks is also often assumed to be ischaemic in origin.Some clinical reviews have, however, stressed the high incidence of "primary" heart block (Zoob and Smith, 1963 ;Johansson, 1966).Initial studies from this hospital suggested that signifi- cant coronary artery disease was not present in most cases of chronic heart block and that pathological changes were often confined to the conduction system (Portal et al., 1962).A detailed post-mortem study of both acute and chronic heart block has now been carried out to define the part played by coronary disease in the production of complete heart block.

with obstructive ASH has just been completed.2 In summary, in our experience, outflow obstruction has been invariably abolished by ventricular myotomy and myectomy, the obstruction has not recurred over prolonged follow-up periods (up to 14 years) and most importantly, symptomatic improvement occurs uniformly and is long-lasting. Although we cannot account for the disappointing operative results cited by Dr. Oakley, the prolonged relief of the obstruction and symptomatic benefit we have observed in patients operated upon at our institution (as well as the good results reported from other centers3'4 suggest an important role for operation in patients with obstructive ASH whose symptoms are inadequately controlled by medical therapy. STEPHEN E. EPSTEIN, M. D. WALTER L. HENRY, M.D. CHESTER E. CLARK, M. D. BARRY MARON, M.D. DAVID R. REDWOOD, M. D. ANDREW G. MORROW, M.D. National Heart and Lung Institute Bethesda, Maryland 20014